In-Hospital Postoperative Adverse Events in Patients with Diabetes Undergoing Elective General or Orthopedic Surgery: A Retrospective Cohort Study from Pakistan

Diabetes is associated with postoperative morbidity, but the pattern of adverse events varies across surgical populations. Objectives: To determine the frequency and pattern of in-hospital postoperative adverse events and examine selected clinical and perioperative correlates among patients with diabetes undergoing elective general or orthopedic surgery. Methods: This retrospective cohort included 300 patients treated at MTI Mardan Medical Complex, Pakistan, from 1 February 2021 to 31 December 2023. Follow-up extended from surgery to discharge or in-hospital death. Welch's t-test and exact tests were used for group comparisons, with Benjamini-Hochberg correction across 23 exploratory comparisons. Results: Twenty-three patients experienced an adverse event (7.7%; 95% CI 5.2%-11.2%). Pre-existing diabetic complications were more frequent in the event group (47.8% vs 17.3%; q=0.016), and mean creatinine was higher (98.49 ± 29.35 vs 70.28 ± 37.46; q=0.004). Age, diabetic comorbidity, surgery category, and mean peripheral glucose did not meet the corrected significance threshold. Anesthesia distribution was similar between groups (p=0.953), and delayed extubation was the most frequent event (8/23). Conclusions: An aggregate endpoint-definition sensitivity check excluding six ambiguously labelled events yielded 17/300 (5.7%). In-hospital postoperative adverse events affected 7.7% of the cohort. Pre-existing diabetic complications and renal status showed the most robust between-group differences, highlighting the importance of end-organ assessment in perioperative risk evaluation.